Long-term Pseudomonas colonization in spinal cord injury patients

In a previous study, patients with spinal cord injuries were observed to have a high incidence of colonizaion of the perineum, rectum, and urethra with Pseudomonas. In the current report, 10 men and 10 women with spinal cord injury were studied prospectively during their stay in hospital between June-Dec. 1977 (men) and Jan.-Nov. 1978 (women). Colonization seen in men (9/10 men: 14 episodes) was significantly more frequent than colonization in women (3/10 women: 5 episodes). Pseudomonas persisted in two or three sites for up to 105 days (mean 47 days) and serotyping showed that colonization was constant with one or two serotypes. Initial colonization occurred most frequently in the perineum and/or rectum. Colonization of the perineum was significantly more frequent than colonization of the rectum or urethra in men. Fifteen episodes of bacteriuria occurred only after (or with) colonization of perineum, urethra, and rectum. Rates of urethral colonization with Pseudomonas were higher in patients with external condom catheters than patients not using the external codon catheter. Urethral and perineal colonization usually resulted in colonization of the drainage bags even when these patients did not have significant bacteriuria. These drainage bags may be an important potential source of Pseudomonas for nosocomial infection. These studies indicate that Pseudomonas infections of the urinary tract may be prevented if acquisition of this pathogen in the perineum and/or rectum can be avoided.